Healthcare Provider Details

I. General information

NPI: 1770675449
Provider Name (Legal Business Name): LATIMER COUNTY HOME HEALTH CARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 EAST MAIN
WILBURTON OK
74578-4232
US

IV. Provider business mailing address

806 HWY 2 NORTH
WILBURTON OK
74578-3625
US

V. Phone/Fax

Practice location:
  • Phone: 918-465-4241
  • Fax: 918-465-5795
Mailing address:
  • Phone: 918-465-4241
  • Fax: 918-465-5795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7018
License Number StateOK

VIII. Authorized Official

Name: MS. DOROTHY LAJUAN REINHARDT
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 918-465-4241